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Introduction Malignant gastric outlet obstruction (MGOO) is a serious complication of advanced malignancy, traditionally managed with surgical bypass or duodenal stenting, but endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) using lumen-apposing metal stents (LAMS) has emerged as a minimally invasive alternative offering durable symptom relief with lower morbidity. This study evaluates the feasibility, safety, and clinical efficacy of EUS-GJ with LAMS in a UK tertiary centre, focusing on length of stay, time to oral intake, and dietary progression assessed using the Gastric Outlet Obstruction Score (GOOS).Methods A retrospective service evaluation was undertaken of 13 consecutive patients undergoing EUS-GJ for MGOO between January 2024 and September 2025, all using a 20 mm LAMS. Primary outcomes were technical success (successful stent deployment) and clinical success (improvement in GOOS). Secondary outcomes included post-procedure hospital stay, time to oral intake, and longitudinal GOOS-based dietary assessment (pre-procedure, >1 week, >1 month, and where available >3, 6, and 12 months).Results Thirteen patients were included (median age 65 years, range 53–89, 10 males, 3 females). Underlying diagnoses were pancreatic cancer (10/13, 76.9%), distal cholangiocarcinoma (1/13, 7.7%), small bowel adenocarcinoma (1/13, 7.7%), and one undiagnosed case. Most obstructions were in D2 (8/13) or the D1/D2 junction (2/13). Technical success was achieved in 12/13 cases (92.3%), with one stent maldeployment managed endoscopically and successfully repeated one week later. Post-procedural complications occurred in 1/13 patients (7.7%): a major haemorrhage requiring ITU admission and transfusion, managed without further sequelae. No delayed complications requiring readmission were observed. Baseline GOOS was G0–G1 (liquid or no oral intake). By 1 week, 8/13 patients (61.5%) had reached G3 (normal diet), and by 1 month, all patients (100%) had achieved and maintained G3. Clinical records documented rapid in-hospital progression from liquids to soft diet within a few days. Post-procedural hospital stay had a median of 7 days (IQR 12, range 0–39), with 8/13 patients discharged within 1 week. Three patients required prolonged admission (>2 weeks) due to other medical issues unrelated to the procedure.Conclusion EUS-GJ with LAMS in a UK tertiary centre is feasible, safe, and highly effective in the palliative management of malignant gastric outlet obstruction. It demonstrates high technical success, rapid resumption of oral intake, and excellent clinical outcomes, with all patients achieving a normal diet by one month. The complication profile is acceptable and manageable, and post-procedure length of stay is compatible with complex oncological care. EUS-GJ should be considered a key minimally invasive alternative to surgical bypass or duodenal stenting, and larger multicentre UK studies are warranted to further validate these findings.